Telescopic surgical device and method therefor

ABSTRACT

An electro-surgical unit (ESU) pencil apparatus includes an improved handpiece which enables the surgeon to vary the length of working electrode without having to use cutting electrodes of varying lengths. This is achieved by installing the electrode in an assembly that may, as desired by the surgeon, be extended from, or retracted into, the body of the ESU pencil apparatus. An uninterrupted RF signal is supplied to the electrode tip and uninterrupted smoke evacuation for the ESU pencil apparatus as the electrode assembly is expanded or retracted. Additionally, a device is provided for locking the electrode assembly at the desired length, so that it does not move during the operation. The ESU pencil apparatus is also adapted for use with an ESU-argon beam coagulator pencil.

This is a continuation-in-part of application Ser. No. 08/196,802, filedFed. 15, 1994, now U.S. Pat. No. 5,431,650, which is a continuation ofapplication Ser. No. 07/989,283, filed Dec. 11, 1992, now abandoned.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates generally to electro-surgical unit (ESU) pencilapparatus and, more specifically, to electro-surgical pencil apparatuswith a variable length electrode and smoke evacuation means, and methodstherefor.

2. Description of the Related Art

In the past, when it was desired to change the length of the electrodeof an ESU pencil, the electrode would be taken out, and replaced withanother of different length. This created a number of problems. First,the electrodes are available only in two or three standard sizes. Thus,if the length desired by the surgeon was different from what wascommercially available, then the surgeon would have to compromise andmake do with the closest available size. Second, changing electrodesduring an operation wastes time. Also, changing electrodes has aneconomic cost. And third, when an extended length electrode is used, theopening to the smoke evacuation conduit is often situated too far fromthe operation site to be effective. This meant that a special smokeevacuation shroud had to be used with the extended electrode, therebyfurther increasing the cost of the operation.

Also, in the past, it had not been possible to use an ESU pencil whileoperating both an argon beam coagulator and a smoke evacuation systemsimultaneously. This was true because the operation of the smokeevacuation system would interrupt the flow of the argon beam before itreached the site of the operation and deflect it directly into the smokeevacuation conduit.

Further, in order to evacuate the smoke from the surgical field inlaparatomy when an ESU pencil handpiece without a smoke collector isused for cutting and coagulation, several methods have been used buttheir performances have not been satisfactory. In order to be efficient,the shroud which performs the smoke collection function must be as closeas possible to the operating tip of the ESU pencil where the smoke isgenerated. But, this solution as embodied in prior art tended toobstruct the surgeon's view of the operation site. Accordingly, therewas a need for an improved handpiece and shroud arrangement whichprovided for efficient smoke collection without obstructing thesurgeon's view of the surgical site.

Therefore, there existed a need for an improved, reusable ESU pencilthat allowed telescoping the electrode assembly containing a standardsize electrode, and provided efficient smoke evacuation at all positionsof the telescopic electrode assembly. Further, these improvements neededto be incorporated into an ESU-argon beam coagulator pencil.

SUMMARY OF THE INVENTION

An object of this invention is to provide an ESU pencil apparatus inwhich the distance between the operating tip of the electrode and thehandpiece is adjustable to the surgeon's desired length, and methodstherefor.

Another object of this invention is to provide a smoke evacuator thatfunctions effectively irrespective of the distance between the operatingtip of the electrode and the handpiece of the ESU pencil, and methodtherefor.

Another object of this invention is to provide an ESU pencil apparatusthat is substantially reusable, and methods therefor.

Another object of this invention is to provide an ESU pencil apparatusthat uses a vortex to increase the efficiency of smoke evacuation, andmethods therefor.

Another object of this invention is to provide an ESU pencil apparatuswhere the distance between the operating tip of the electrode and theintake to the smoke evacuation conduit is adjustable, thereby enablingthe surgeon to optimize the exhaust suction and visibility of theoperating site, and methods therefor.

Another object of this invention is to provide an ESU pencil apparatusthat combines an argon gas coagulator with a smoke evacuation system,and methods therefor.

Another object of this invention is to provide an improved smokeevacuation shroud apparatus for use with, but not limited to, anelectro-surgical, an ESU-argon beam coagulator pencil, or a lasersurgical unit, and methods therefor.

Another object of this invention is to provide an improved smokeevacuation shroud apparatus for use with, but not limited to, a lasersurgical, an electro-surgical, or an ESU-argon beam coagulator pencilunit in which the smoke evacuation shroud provides efficient smokecollection without obstructing the surgeon's view of the surgical site,and methods therefor.

Another object of this invention is to provide an improved smokeevacuation shroud apparatus for use with, but not limited to a lasersurgical, an electro-surgical, or an ESU-argon beam coagulator pencilunit in which the smoke evacuation shroud provides efficient smokeremoval by creating a vortex in the vicinity of the surgical site, andmethods therefor.

BRIEF DESCRIPTION OF THE PREFERRED EMBODIMENTS

In accordance with one embodiment of this invention, an electro-surgicalunit (ESU) pencil apparatus is disclosed comprising, in combination,cutting means for cutting and coagulating in a medical procedure, smokeevacuation means coupled to the cutting means for removing smoke anddebris produced during the medical procedure, and telescopic membermeans coupled to the cutting means and to the smoke evacuation means foradjusting position of the cutting means and the smoke evacuation meansalong a lengthwise axis of the ESU pencil. It is well known in the artto provide cutting means that both cut and coagulate. The smokeevacuation means comprises a vacuum source, tubular member means coupledto the vacuum source for conveying the smoke and debris to the vacuumsource, locking means coupled to the tubular member means and to thetelescopic member means for holding a selected portion of the telescopicmember means, and nozzle means coupled to the telescopic member meansfor evacuating the smoke and debris in proximity to a working site forthe medical procedure. Additionally, the nozzle means has connectionmeans for removably connecting the nozzle means to the telescopic membermeans. The telescopic member means comprises a tubular member slidablyretained within conductive element means, conductive cap means coupledto a portion of the tubular member for conducting energy, conductivetang means, extending from a portion of the conductive cap means andcontacting an inner surface portion of the conductive element means, forconducting the energy from the conductive element means to theconductive cap means, conducting member means supported within thetubular member for conducting the energy from the conductive cap means,conductive support means coupled between the conductive cap means andthe conducting member means for conducting the energy from theconductive cap means to the conducting member means, electrode retainermeans coupled to the conducting member means for retaining the cuttingmeans and for transferring the energy to the cutting means, and vortexsupport means coupled to the conducting member means for supporting theconducting member means and for assisting formation of vortex flow ofthe smoke and debris. The ESU pencil apparatus further includes switchmeans for selectively applying the energy from an energy source via aconnector to the conductive element means.

In accordance with another embodiment of this invention, an ESU-Argonbeam coagulator pencil apparatus is disclosed comprising, incombination, cutting means for cutting in a medical procedure,coagulation means coupled to the cutting means for coagulating apatient's blood, smoke evacuation means coupled to the coagulation meansfor removing smoke and debris produced during the medical procedure, andtelescopic member means coupled to the cutting means, the coagulationmeans, and the smoke evacuation means for adjusting position of thecutting means, the coagulation means, and the smoke evacuation meansalong a lengthwise axis of the pencil apparatus. The smoke evacuationmeans comprises a vacuum source, tubular member means coupled to thevacuum source for transferring the smoke and debris to the vacuumsource, locking means coupled to the tubular member means and to thetelescopic member means for holding a selected portion of the telescopicmember means, and nozzle means coupled to the telescopic member meansfor evacuating the smoke and debris in proximity to a working site forthe medical procedure. The nozzle means has connection means forslidably connecting the nozzle means to a portion of the telescopicmember means and for forming a substantially air-tight connectionbetween the nozzle means and the telescopic member means. The connectionmeans includes notch means in a surface portion of the nozzle means forreceiving a protrusion extending from a surface portion of thetelescopic member means. The pencil apparatus further includesconductive element means coupled to an interior surface of the tubularmember means for conducting energy supplied from an energy source. Thetelescopic member means comprises a tubular member slidably retainedwithin the conductive element means, conductive cap means coupled to aportion of the tubular member for conducting the energy, conductive tangmeans, extending from a portion of the conductive cap means andcontacting an inner surface portion of the conductive element means, forconducting the energy from the conductive element means to theconductive cap means, conducting member means supported within thetubular member for conducting the energy from the conductive cap means,conductive support means coupled between the conductive cap means andthe conducting member means for conducting the energy from theconductive cap means to the conducting member means, electrode retainermeans coupled to the conducting member means for retaining the cuttingmeans and for transferring the energy to the cutting means, and vortexsupport means coupled to the conducting member means for supporting theconducting member means and for assisting formation of a vortex flow ofthe smoke and debris. The coagulation means comprises coagulatingmaterial supply, conduit means coupled to the coagulating materialsupply and to the hollow tube for conveying coagulating material fromthe coagulating material supply to the hollow tube, and delivery meanscoupled to the hollow tube for delivering the coagulating material tocoagulate the blood. The coagulating material could be argon gas orother fluid. The delivery means comprises a tubular conduit extendingthrough the nozzle means and beyond an end portion of the nozzle means,and the tubular conduit includes means for preventing suction of thecoagulating material directly into the smoke evacuation means.

In accordance with yet another embodiment of this invention, an ESUpencil apparatus is disclosed comprising, in combination, a removableelongated shroud, adaptably fitted over the external surface of an ESUpencil apparatus, electro-surgical means located within a portion of theshroud and having electro-surgical tip means that extend below anopening located at a distal portion of the shroud for use in surgery,conduit means located within the elongated shroud having a taperedportion surrounding a portion of the electro-surgical means and incommunication with the opening at the distal portion of the elongatedshroud and an enlarged portion extending outwardly from the portion ofthe electro-surgical means and the tapered portion to a proximal openingin the elongated shroud for both increasing suction of smoke from theopening located at the distal portion of the shroud upwardly to theproximal opening in the elongated shroud and increasing visibility ofthe tip means below the opening in the distal portion of the shroud topermit better visualization of the surgery, external conduit meanscoupled to the proximal opening in the elongated shroud for exhaustingsmoke located within the shroud, and smoke evacuation means coupled tothe external conduit means for exhausting smoke passing from the conduitmeans into the external conduit means.

In accordance with still another embodiment of this invention, a shroudfor use with an ESU pencil apparatus is disclosed comprising, incombination, a removable elongated shroud, adaptably fitted over anexternal surface of the ESU pencil, electro-surgical means locatedwithin a portion of the shroud and having coagulation beam means coaxialwith and surrounding retractable electro-surgical tip means that, whenextended, reach below an opening located at a distal portion of theshroud for use in surgery, conduit means located within the elongatedshroud having a tapered portion surrounding a portion of theelectro-surgical means and in communication with the opening at thedistal portion of the elongated shroud and an enlarged portion extendingoutwardly from the portion of the electro-surgical means and the taperedportion to a proximal opening in the elongated shroud for bothincreasing suction of smoke from the opening located at the distalportion of the shroud upwardly to the proximal opening in the elongatedshroud and increasing visibility of the tip means below the opening inthe distal portion of the shroud to permit better visualization of thesurgery, external conduit means coupled to the proximal opening in theelongated shroud for exhausting smoke located within the shroud, andsmoke evacuation means coupled to the external conduit means forexhausting smoke passing from the conduit means into the externalconduit means.

In accordance with still another embodiment of this invention, a shroudapparatus for use with a surgical laser unit is disclosed comprising, incombination, a removable elongated shroud adaptably fitted over anexternal surface portion of the surgical laser unit, and having anopening in proximity to a tip portion of the removable elongated shroud,surgical laser means located within a portion of the elongated shroudfor use in surgery, conduit means constrained by a tapered interiorsurface of the elongated shroud and in communication with the openingfor both increasing suction of smoke from the opening to a proximalopening in the elongated shroud and for increasing visibility of thesurgery, external conduit means coupled to the proximal opening in theelongated shroud for exhausting smoke located within the shroud, andsmoke evacuation means coupled to the external conduit means forexhausting smoke passing from the conduit means into the externalconduit means. The pencil apparatus further includes clamping meanscoupled to the elongated shroud for holding the surgical laser means.The tip portion of the elongated shroud extends beyond a portion of theclamping means for providing measuring means for establishing a minimumsafe distance at which the surgical laser means can be operated in thesurgery.

The foregoing and other objects, features, and advantages of theinvention will be apparent from the following, more particular,description of the preferred embodiments of the invention, asillustrated in the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an ESU pencil apparatus according to thepresent invention, with the telescopic electrode assembly extended.

FIG. 2 is a perspective view of the apparatus in FIG. 1 with thetelescopic surgical electrode assembly retracted.

FIG. 3 is an exploded view of the apparatus in FIG. 1.

FIG. 4 is a cross-sectional view of the apparatus in FIG. 1.

FIG. 5 is a cross-sectional view of an ESU-argon beam coagulator pencilapparatus in accordance with the present invention.

FIG. 6 is a side view of the electrode of the ESU pencil apparatus inFIG. 5.

FIG. 6B is a cross-sectional view of the nozzle of the ESU pencilapparatus in FIG. 5.

FIG. 6C is a cross-sectional view of the telescopic assembly of the ESUpencil apparatus in FIG. 5. FIG. 7A is a cross-sectional view of thenozzle in FIG. 6B, taken along line 7A--7A.

FIG. 7B is a cross-sectional view of the nozzle in FIG. 6B, taken alongline 7B--7B.

FIG. 7C is a cross-sectional view of the telescopic assembly in FIG. 6B,taken along line 7C--7C.

FIG. 7D is an enhanced view of the nozzle and distal end of thetelescopic assembly, showing the locking mechanism for the nozzle of theESU pencil apparatus in FIG. 5.

FIG. 8A is a perspective view of an ESU pencil apparatus and shroud inaccordance with the present invention.

FIG. 8B is a perspective view of an extended nozzle for the ESU pencilapparatus in FIG. 8A.

FIG. 8C is a side view of an extended electrode with a blade tip for theESU pencil apparatus in FIG. 8A.

FIG. 8D is a side view of a ball electrode tip for the ESU pencilapparatus in FIG. 8A.

FIG. 8E is a side view of a needle electrode tip for the ESU pencilapparatus in FIG. 8A.

FIG. 8F is an end view of the apparatus in FIG. 8A, taken from near theelectrode tip.

FIG. 8G is an end view of another embodiment of the apparatus in FIG.8A, taken from near the electrode tip.

FIG. 9A is a perspective view of an ESU-argon beam coagulator pencilapparatus and shroud, with the nozzle and electrode retracted, inaccordance with the present invention.

FIG. 9B is a perspective view of the apparatus in FIG. 9A, with thenozzle and electrode extended.

FIG. 10A is a perspective view of another embodiment of the shroud foruse with ESU-argon beam coagulator pencil apparatus, in accordance withthe present invention.

FIG. 10B is a perspective view of another embodiment of an ESU-argonbeam coagulator pencil apparatus with the shroud in FIG. 10A.

FIG. 11A is a perspective view of a laser surgical unit apparatus andshroud in accordance with the present invention.

FIG. 11B is a perspective view of the laser surgical unit apparatus inFIG. 11A, FIG. 11C is a perspective view of a laser tip for use with theapparatus in FIG. 11B, FIG. 11D is a perspective view of the shroud inFIG. 11A,

DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIGS. 1, 2, 3 and 4 depict an electro-surgical unit (ESU)pencilapparatus 21 with a telescopic assembly 24. The tip of the electrode 12is defined as the distal end of the ESU pencil apparatus 21 and theopposite end, the exhaust port 15, is defined as the proximal end.Hereafter in the specification, this definition is the reference for theuse of the terms "distal end" and "proximal end" with respect to eachelement of the ESU pencil apparatus 21. The handpiece 22 has a lockingcap 1 coupled to the distal end 25 of the handpiece 22 and an exhaustconnector 13 attached to the proximal end 26 of the handpiece 22. Thetubular inner surface of the handpiece 22 is lined with a cylindricalconducting element 3.

RF energy flows to the ESU pencil apparatus 21 from an RF source (notshown) via cord 14. Note that those skilled in the art refer to such anRF source as an ESU, and the working tool 21 is typically called an ESUpencil. On the outside of the handpiece 22 is a hand switch 4, whichcontrols the supply of RF energy from the cord 14 to the conductingelement 3. Note that it is well known in the art to supply RF energy ofa first specification for cutting and RF energy of a differentspecification for coagulation. The switch 4 alternatively activates bothtype of RF energy.

The telescopic assembly 24 is contained within the conducting element 3.The outer diameter of the tubing 9, which forms the body of thetelescopic assembly 24, is marginally smaller than the inner diameter ofthe conducting element 3, permitting the telescopic assembly 24 to slidealong the longitudinal axis of the conducting element 3. A rod 5 issuspended inside the tubing 9 by means of two spacers 34 and 35. Theplurality of fins 7 on the spacer 34 are slanted relative to the generaldirection of the flow of smoke and other fluids through the tubing 9,such that a vortex is created when the fluids flow past these fins 7.The rod 5, and the spacers 34 and 35, are made of conducting material.The socket 8 is located at the distal end of the spacer 34. Theelectrode 12 is removably coupled with the socket 8. Alternatively, theelectrode 12 could be integral with the socket 8.

At the proximal end of the tubing 9 is the conductor cap 6. Theconductor cap 6 is a thin tubular strip of metal that circles theoutside of the proximal end 33 of the tubing 9, and allows fluid accessto the inside of the tubing 9 from the proximal end 33. The outersurface of the tubing 9 at the proximal end 33 is slightly depressed sothat the outer surface of the conductor cap 6 is flush with the outersurface of the tubing 9. The conductor cap 6 has electrical contact withthe spacer 35. The spacer 35 is located at the proximal end 33 on theinside of the tubing 9. The conductor cap 6 has a plurality of tangs 23that provide an electrical link between the conductor cap 6 and theconducting element 3.

At the distal end 32 of the tubing 9 is the nozzle 11. The nozzle 11 ishollow and tapered on its interior and exterior surfaces as viewed fromnear its proximal end 36 to its distal end 17. This tapering not onlyhelps to increase the visibility of the tip of the electrode 12 and thesite of the operation, but also increases the efficiency of the fluidremoval from the operation site by creating an exhaust vortex near theoperation site. Formation of the vortex is explained in detail later.Making the nozzle 11 from a transparent material further aids thevisibility.

A portion near the proximal end 36 of the nozzle 11 is cylindrical andthe outer diameter of the nozzle 11 is nearly equal to the innerdiameter of the tubing 9 so that a substantially air-tight connection isformed when the proximal end 36 of the nozzle 11 is inserted into thedistal end 32 of the tubing 9. A locking mechanism is also provided tosecure the connection between the nozzle 11 and the tubing 9. The pin 16on the nozzle 11 is designed to fit into the L-shaped slot 37 at thedistal end 32 of the tubing 9. A secure connection is made by slidingthe pin 16 into the slot 37 and twisting the nozzle 11. An alternativeembodiment of the telescopic assembly 24 would have the nozzle 11 as anintegral part of the tubing 9.

The telescopic assembly 24 is held in position within the handpiece 22by the locking cap 1. The exterior of the locking cap 1 is conical atthe distal end and substantially tubular at the proximal end. However,the inside of the locking cap 1 is hollow and cylindrical. The innerdiameter of the locking cap 1 is only marginally greater than the outerdiameter of the tubing 9.

The tubing 9 passes through the locking cap 1. The locking cap 1 isdesigned to connect to the distal end 25 of the handpiece 22, with thelocking cap threads 27 engaging the handpiece threads 28. The lockingcone 30 on the inner surface of the handpiece 22 is conical with thediameter at the proximal end 31 of the locking cone 30 being less thanthat at the distal end of the locking cone. As the locking cap 1 isscrewed into the distal end 25 of the handpiece 22, the slotted flanges29 at the proximal end of the locking cap 1 press into the decreasingdiameter of the locking cone 30. Thus, the flanges 29 are pressed inwardby the decreasing inner diameter of the locking cone 30, securing thetelescopic assembly 24 to the handpiece 22.

The distal end of the exhaust connector 13 fits into the proximal end 26of the handpiece 22. The sleeve 38, at the distal end of the connector13, is of marginally lesser outer diameter than the inner diameter ofthe proximal end 26 of the handpiece 22, so that a substantiallyair-tight connection between the sleeve 38 and the handpiece 22 isformed. Note, threaded engagement or other means of connecting wellknown in the art are acceptable to connect the exhaust connector 13 tothe handpiece 22. Alternatively, the exhaust connector 13 could beintegral with the proximal end 26 of the handpiece 22. At the proximalend of the connector 13 is the exhaust port 15 that is connected tosuction tubing (not shown).

FIGS. 5, 6A-C, and 7A-C depict an ESU-Argon beam coagulator pencilapparatus 121 with telescopic assembly 124, in accordance with thepresent invention. The tip of the electrode 112 is defined as the distalend of the ESU-argon beam coagulator pencil apparatus 121 and theopposite end, the exhaust port 164, is defined as the proximal end. Aspreviously explained, the ends of all other elements of the ESU-argonbeam coagulator pencil apparatus 121 are referenced with respect to thisdefinition of the distal and proximal ends.

The handpiece 122 has a locking cap 101 coupled to the distal end of thehandpiece 122. An exhaust connector 113 is coupled to the proximal endof the handpiece 122. The handpiece 122 is similar to the earliermentioned handpiece 22, except that the handpiece 122 has an additionalhand switch 150 for regulating the supply of coagulating material to theinlet port 162. While the invention has been particularly described withargon gas as the inert material supplied, other inert fluids too couldbe supplied as the inert material. The inside of the handpiece 122 islined with a cylindrical conducting element 103. On the outside of thehandpiece 122 are two hand switches 104 and 150. Handswitch 104regulates the supply of RF energy from an RF source (not shown) via acord 114 to the conducting element 103. Hand switch 150 regulates theflow of argon to the inlet port 162.

The telescopic assembly 124 (shown in greater detail in FIG. 6C) iscontained within the conducting element 103. The telescopic assembly 124is similar to the previously described telescopic assembly 24. The outerdiameter of the cylindrical tubing 109, which forms the body of thetelescopic assembly 124, is marginally smaller than the diameter of theconducting element 103, permitting the telescopic assembly 124 to slidealong the longitudinal axis of the conducting element 103. A thin hollowrod 105 is suspended inside the tubing 109 by means of two spacers 134and 135. The plurality of fins 107 on the spacer 134 are slantedrelative to the longitudinal axis of the tubing such that a vortex iscreated when smoke and other fluids flow past the fins 107. The socket108 is located inside the distal end of the rod 105. The spacers 136 and137 suspend the socket 108 inside the rod 105. The electrode 112 isremovably coupled with this socket 108. Alternatively, the electrode 112could be integral with this socket 108. The rod 105, and the spacers135, 136, and 137 are made of conducting material.

At the proximal end of the tubing 109 is the conductor cap 106. It is athin tubular strip of metal that circles the outside of the proximal endof the tubing 109, and allows fluid access to the inside of the tubing109 from the proximal end of the tubing 109. The outer surface of thetubing 109 at the proximal end is slightly depressed so that the outersurface of the conductor cap 106 is flush with the outer surface of thetubing 109. The conductor cap 106 has an electrical contact with thespacer 135. The spacer 135 is located at the proximal end on the insideof the tubing 109. The conductor cap 106 has a plurality of tangs 123that provide an electrical link between the conductor cap 106 and theconducting element 103.

Coupled to the distal end of the tubing 109 is the nozzle assembly 111.The nozzle 151 forms the exterior of the nozzle assembly 111. The distalsection of the nozzle 151 is conical, whereas the proximal section ofthe nozzle 151 is cylindrical At the distal end of the nozzle 151 is anaperture, and the diameter of the aperture increases towards the middleof the nozzle 151. From about the middle of the nozzle 151 to itsproximal end, the nozzle is cylindrical. The inner diameter of theproximal end of the nozzle 151 is marginally larger than the outerdiameter of the tubing 109 such that there is a substantially air-tightconnection between the two, and yet the nozzle 151 can slide freely overthe tubing 109.

The tapering of the distal section of the nozzle 151 not only helps toincrease the visibility of the tip of the electrode 112 and the site ofthe operation, but also increases the efficiency of the fluid removalfrom the operation site by creating an exhaust vortex near the operationsite. Formation of the vortex is explained in detail later. Making thenozzle 151 from a transparent material further aids the visibility.

A locking mechanism (shown more clearly in FIG. 7D) prevents the nozzlefrom accidentally slipping out from over the telescopic assembly 124.The locking mechanism is comprised of a U-shaped channel 120, and alocking tab 102. The channel 120 is cut on the inner surface of thenozzle 151. The locking tab 102 is a protrusion located near the distalend of the tubing 109 and runs in the channel 120 when the nozzle 151 iscoupled to the tubing 109. The channel 120 has two legs 161 and 165,running circumferentially around the longitudinal axis of the nozzle151. A bridge 163, running longitudinally, connects the two legs. Theleg 165 traverses a substantial distance along the inner circumferenceof the nozzle and has access from the proximal edge of the nozzle 151.The termination of the leg 165 at the proximal end of the nozzle 151forms a loop to prevent the locking tab from accidentally slipping outof the channel 120.

When the nozzle assembly 111 is inserted over the telescopic assembly124 the locking tab 102 is maneuvered into the leg 165. When the nozzleassembly 111 is to be slid to and fro relative to the telescopicassembly 124, the locking tab 102 moves in the bridge 163 of the channel120. When the locking tab 102 is in leg 161, the mouth 154 will coverthe tip of the electrode 112. To remove the nozzle assembly 111, thelocking tab 102 is maneuvered past the loop of the leg 165. Note, otherforms of locking mechanisms known in the art are also acceptable forlocking the nozzle assembly 111 over the telescopic assembly 124.

Another component of the nozzle assembly 111 is a tubular argon conduit152 located inside the nozzle 151. The conduit 152 is substantiallycylindrical. The diameter of the conduit 152 is marginally larger thanthat of the rod 105 such that a substantially air-tight, yet slidable,connection is formed when the distal end of the rod 105 is inserted intothe proximal end of the conduit 152. A plurality of spacing vanes 153are attached to the outer surface of the conduit 152 so as to suspendthe conduit 152 inside the nozzle 151. Further, these spacing vanes 153are slanted relative to the axial flow of smoke and other fluids throughthe nozzle assembly 111 so as to create a vortex flow. The mouth 154 ofthe conduit 152 extends beyond the distal end of the nozzle 151. Themouth 154 flares out to prevent the argon gas coming out of the conduit152 from being immediately drawn into the smoke duct 155.

The locking cap 101 is similar to the previously discussed lockingcap 1. As the locking cap 101 is screwed into the distal end of thehandpiece 122, the cap 101 will circumscribe a portion of the telescopicassembly 124 and lock the telescopic assembly 124 into place.

The distal end of the connector 113 is designed to fit into the proximalend of the handpiece 122. A sleeve 138, at the distal end of theconnector 113 is of narrower outer diameter than the inner diameter ofthe proximal end of the handpiece 122, such that the sleeve 138 forms atight seal when inserted into the proximal end of the handpiece 122.Note, threaded engagement or other means of connecting well known in theart may be implemented to connect the exhaust connector 113 to thehandpiece 122. Alternatively, the connector 113 could be integral withthe handpiece 122.

At the proximal end of the connector 113 are two ports--the exhaust port164 and the inlet port 162. The exhaust port 164 is connected to asuction source (not shown) via tubing (not shown), and the inlet port162 is connected to an argon supply (not shown). Inside the inlet port162 is a long, narrow, tubular member 160, whose distal end is insertedinto the proximal end of the rod 105. The outer diameter of the tubularmember 160 is marginally less than the inner diameter of the rod 105such that a substantially air-tight, yet slidable connection is madebetween the tubular member 160 and the rod 105 when the tubular member160 is partially inserted into the rod 105. The length of the tubularmember 160 is sufficient as to ensure uninterrupted flow of argon gaseven when the telescopic assembly 124 is fully extended from thehandpiece 122.

FIGS. 6A-C and 7A-C depict some of the elements of the ESU pencilapparatus shown in FIG. 5. FIG. 6A depicts a side view of the electrode112. FIG. 6B depicts a cross-sectional view of the nozzle assembly 111.FIG. 6C depicts a cross-sectional view of the telescopic assembly 124.FIG. 7A depicts the cross-sectional view of the nozzle assembly 111taken through the spacing vanes 153. FIG. 7B is an cross-sectional viewnear the proximal end of the nozzle assembly 111. FIG. 7C is ancross-sectional view from near the distal end of the telescopic assembly124.

FIGS. 8A-G show another embodiment of an ESU pencil apparatus 402 andsmoke evacuation assembly or shroud 410 according to the presentinvention. This embodiment adopts the smoke evacuation assembly(hereinafter shroud) 410 for use with electrodes 406 of various lengths.The handpiece holder 421 is shaped to hold the handpiece 405 of an ESUpencil apparatus 402. The tip of the electrode 406 passes throughelectrode opening 422, the nozzle 412, and the exhaust opening 424. Theelectrode opening 422 is shaped to substantially conform to the distalend of the handpiece 405. The electrode opening 422 not only helps tosupport the ESU pencil apparatus 402, but also forms a substantiallyairtight seal around the contacting surface portion of the handpiece405. Handswitch 404 regulates the RF supply to the electrode 406.

The nozzle 412 is detachably coupled to the connecting neck 426 of theshroud 410. Alternatively, the nozzle 412 could be integral to theshroud 410. The passageway 428 inside the nozzle 412, while quite narrowat the exhaust opening 424, widens sharply towards the connecting neck426. The chute 420 is located alongside the handpiece holder 405, andforms a path between the exhaust port 416 and the passageway 428. Theexhaust port 416 connects the chute 420 to a suction source (not shown).

The tapering of the passageway 428 not only helps to increase thevisibility of the tip of the electrode 406 and the site of theoperation, but also increases the efficiency of the fluid removal fromthe operation site by creating an exhaust vortex near the operationsite. Formation of the vortex is explained in detail later. Making thenozzle 412 from a transparent material further aids the visibility.

When an extended electrode 430 (FIG. 8C), needs to be used with the ESUpencil apparatus 402, the exhaust opening 424 will be too far from theblade tip 436 to establish an effective exhaust flow in proximity of theblade tip 436. In such circumstances, the nozzle 412 is detached fromthe shroud 410, and is replaced with elongated nozzle 425 (FIG. 8B). Theextended electrode 430 has a spacer 432 with a plurality of fins 434that help stabilize the extended electrode 430 within the elongatednozzle 425. If slanted to the general direction of the fluid flowthrough the elongated nozzle 425, the fins 434 could be used to increasethe efficiency of the vortex created by the venturi effect of theelongated nozzle 425. Note that there are many different angles at whichthe fins 434, or any other fins herein may be situated to assist vortexflow. The tip of the extended electrode 430 could be of differenttypes--for example, a blade electrode (436--FIG. 8C), ball electrode(440--FIG. 8D), or a needle electrode (450--FIG. 8E).

FIGS. 8F and 8G depict the end views of two embodiments of the presentinvention. These end views are taken from near the tip of the electrode406. FIG. 8F is the end view of the apparatus shown in FIG. 8A. Here,the side of the chute 420 adjacent to the handpiece holder 421 is shapedto conform substantially to the shape of the handpiece holder 421. FIG.8G is the end view of a apparatus according to the present invention inwhich the chute 423 is substantially cylindrical.

Whereas FIGS. 8A-G show adaptation of the invention for use with a ESUpencil apparatus 402, FIGS. 9A-B, and 10A-B show two more embodiments ofthe present invention for use with two types of ESU-argon beamcoagulator pencils 502 and 602. FIGS. 9A-B show the adaptation of theshroud 510 for use with an ESU-argon beam coagulator pencil apparatus502. In ESU-argon beam coagulator pencil apparatus 502 the argon beam(for coagulation) surrounds the electrode 506. The electrode 506 isactivated by handswitch 503, and the argon beam by handswitch 504. Thebolt 501 allows the electrode 506 to be extended (see FIG. 9B) andretracted (see FIG. 9A). The exhaust port 516 connects the shroud 510 toa suction source (not shown) via a smoke evacuation channel (not shown).

The nozzle 512 is tapered and preferably made of transparent material.This helps to increase the visibility of the operation site and of thetip of the electrode 506. The smoke and other fluids from the operationsite enter the nozzle through a narrow opening at the tip 524 andproceed into a wider passageway inside the nozzle 512. The resultantventuri effect increases the efficiency of fluid removal from theoperation site by creating an exhaust vortex near the operation site.Formation of the vortex is explained in detail later.

A novel feature of shroud 510 is the adjustable nozzle 512. A portion ofthe nozzle 512 is designed to slide within a neck piece 513 and lock intwo extreme positions--one retracted (see FIG. 9A) and the otherextended (see FIG. 9B). When the nozzle 512 is retracted, it exposes theargon conduit tip 532. When the nozzle 512 is extended, the tip of thenozzle 524 covers the argon conduit tip 532, and is designed to be nearthe blade tip 507 of the extended electrode 506, thus ensuring anefficient smoke removal near the blade tip 507.

FIGS. 10A-B illustrate the adaptation of the shroud 610 for use over anESU-argon beam coagulator pencil apparatus 602 in which the argonconduit 630 is set apart from electrode 606. FIG. 10A shows just theshroud 610, and 10B shows the shroud 610 fitted over the ESU-argon beamcoagulator pencil apparatus 602. Handswitch 604 controls the RF energysupply to the electrode 606, and handswitch 603 controls the argonsupply. The bolt 601 allows the electrode 606 to be extended andretracted. A suction source, for removing the smoke from the site of theoperation, is applied to the shroud 610 through the exhaust port 616.The electrode passes through the nozzle 612. The tapered nozzle 612 onceagain produces a vortex around the tip of the electrode 606. A conduitaccess 628 fits around the conduit 630.

FIGS. 11A-D show the adaptation of the shroud 710 for use with a lasersurgery pencil apparatus 702. The laser surgery pencil apparatus 702 isdepicted in FIG. 11B, and the shroud 710 is depicted in FIG. 11D. Thehandpiece 704 of the laser surgical pencil apparatus 702 is generally ofconical shape, but the shape of the handpiece is not a constraint foradaptation of the present invention. Near the handpiece tip 705 of thelaser surgery pencil apparatus 702 is a cylindrical neck 706. When thehandpiece 704 is used without the shroud 710, the clip 709 of focusingcap 707 (see FIG. 11C) fits over the neck 706 and tip 708 of thefocusing cap 707 marks the minimum safe operating point of the lasersurgical pencil apparatus 702

When laser surgical pencil apparatus 702 is used with the shroud 710,the focusing cap 707 is removed from the neck 706 and the neck 706 isinserted into the passage 728 inside the holder 726 (see FIG. 11D). Theshroud 710 fits around the laser surgical pencil apparatus 702 with theclamp 721 securing the head 730 of the laser surgical pencil apparatus702. A groove 722 in the clamp 721 locks around the cleaning gas inlet732 so as to provide more stability to the fitting of the shroud 710around the laser surgical pencil apparatus 702. The shroud tip 725provides measurement of the minimum safe operation point for the lasersurgical pencil apparatus 702.

The smoke inlet 724 is located near the shroud tip 725. An alternateembodiment would be to have more than one shroud tip 725, each with itsown smoke inlet 724. The smoke inlet 724 is narrow and opens into arelatively wider exhaust chute 720, which steadily widens as it movesaway from the smoke inlet 724. At the other end of the passageway is theexhaust port 716, which is connected to a suction apparatus (not shown).

A venturi effect on the fluid passing through the smoke inlet 724increases the efficiency of the fluid removal from the operation site bycreating an exhaust vortex near the operation site. Formation of thevortex is explained in detail later. Making the shroud tip 725 from atransparent material further aids the visibility.

OPERATION

Referring to FIGS. 1, 2, 3 and 4, the RF supply (not shown) to the ESUpencil apparatus 21 is controlled by means of the hand switch 4. The RFenergy flows from cord 14 to the conducting element 3. From theconducting element 3, the RF energy reaches the conductor cap 6 throughthe tangs 23. The tangs 23 press against the conducting element 3.Because the conducting element 3 extends over the range of motion forthe tangs 23 along the longitudinal axis of the telescopic assembly 24,the electrical contact between the tangs 23 and the conducting element 3is continuous. From the conductor cap 6, the RF energy passes on to thespacer 35, the rod 5, spacer 34, and the electrode 12.

The smoke and other debris created during the surgical procedure isremoved through the exhaust connector 13, located at the proximal end 26of the handpiece 22. The smoke is sucked out from the exhaust connector13 by suction means (not shown) such as a vacuum pump, via suctiontubing (not shown)that is connected to exhaust port 15. The passagewayfor the smoke and other fluids from the site of the operation to theexhaust port 15 is as follows: the fluids enter the ESU pencil apparatus21 through the distal end 17 of the nozzle 11. The fluids then flow pastthe spacer 34, the rod 5, the spacer 35, the handpiece 22, and enter theexhaust connector 13. The locking cap 1, which is coupled with thehandpiece 22, forms an airtight seal with the handpiece 22, and theslotted flanges 29 fit tightly over the tubing 9 forming anotherairtight connection with the outer surface of the tubing 9. Theseairtight connections prevent air flow through the annular space betweenthe conducting element 3 and the outer surface of the tubing 9.

The tapered shape of the nozzle 11 not only increases the visibility ofthe area being operated upon but also increases the efficiency of thesmoke removal from the operation site. Since the distal end 17 of thenozzle 11 leads into a wider passageway inside the nozzle 11, a venturieffect causes an acceleration of these fluids as they pass through thedistal end 17. The pressure drop in the passageway immediately beyondthe distal end 17 is large enough to produce a spiraling or "vortex"fluid flow through the nozzle 11. This vortex soon extends to surroundthe tip of the electrode 12. The vortex increases the efficiency of thesmoke removal. The vortex is enhanced by the spacer 34 since theplurality of fins 7 is angled to the general direction of the flow ofthe fluids. Note, while providing structures(such as fins 7) inside thepassageway of the fluids can enhance the efficiency of the vortex, suchstructures are not a requirement for the creation of a vortex.

When the surgeon desires to change the distance of the tip of theelectrode 12 from the handpiece 22, the locking cap 1 is loosened. Thisreleases the grip of the locking cap 1 on the telescopic assembly 24,and it may now be extended or retracted as desired. When the desiredlength is reached, the locking cap 1 is tightened again, and thetelescopic assembly 24 is locked into position. Since the distal end 17is always near the tip of the electrode 12 irrespective of the positionof the telescopic assembly 24 within the hand piece 22, the efficiencyof smoke removal is not effected by the sliding of the telescopicassembly 24. Depending on how much of the tip of the electrode 12 thesurgeon desires to have exposed, a nozzle 11 of appropriate size andshape may be used. After the operation, the electrode 12, the telescopicassembly 24, the nozzle 11, and locking cap 1 are disposed of, but thehandpiece 22 and exhaust connector 13 may be reused.

Referring to FIGS. 5, 6A-C, and 7A-C, a major additional featureintroduced in this embodiment is the argon beam, whose activation iscontrolled through the hand switch 150. The argon beam is conveyed tothe site of the surgical procedure through the inlet port 162, thetubular member 160, the rod 105, conduit 152 and finally the mouth 154.The unique shape of the mouth 154 of the conduit 152 shields the argonbeam from the exhaust suction, as will be explained below.

Smoke and other fluids from the operation site are removed through thesmoke duct 155 by coupling a suction source (not shown) to the exhaustport 164. Smoke and other fluids from the operation site are sucked intothe smoke duct 155 through the annular space between the mouth 154 ofthe conduit 152 and the tip 117 of the nozzle 151. As previouslyexplained, since the distal end of the smoke duct 155 tapers, and sincethe entrance to the smoke duct 155 is narrow, the venturi effectproduced creates a vortex around the site of the operation. Theplurality of spacing vanes 153 near the tip 117 are angled to thedirection of the flow of the smoke and thus aid in the creation of thevortex.

In the absence of the mouth 154, the suction from the smoke duct 155would tend to draw the argon beam directly into the smoke duct 155 priorto reaching the operation site, because the inlet of the smoke duct 155surrounds the conduit 152 (i.e. argon beam outlet). This is a problemthat prior technology has been unable to solve. Now, this problem hasbeen solved by having the outlet of the argon beam passageway (i.e. themouth 154 of the conduit 152) extend a little beyond the inlet of thesmoke duct 155 (i.e. the tip 117 of the nozzle 151),and having the mouth154 flare out. The mouth 154 deflects the exhaust vortex made by thesmoke duct 155, and forms an eye of relative calm in the middle of thevortex. Since the tip of the electrode 112 is located in the middle ofthis calm, the argon beam proceeds unhindered to the site of theoperation. As smoke is created as a result of the operation, it will bepushed outward by the argon beam, where it will be captured by theexhaust vortex.

Sliding the nozzle assembly 111 over the tubing 109 enables the surgeonto vary the length of the tip of the electrode 112 that the surgeondesires to expose. The range of movement for the nozzle assembly 111 isdetermined by the locking mechanism. The locking tab 102 of the lockingmechanism moves along the bridge 163 of the channel 120, and the loop onthe leg 165 prevents the nozzle 151 from accidentally slipping out fromover the tubing 109.

The working of the telescopic assembly 124 is similar to that explainedearlier for the telescopic assembly 24. The smoke is conveyed from theoperation site through the smoke duct 155, the tubing 109, the handpiece122, the exhaust connector 113, and through the exhaust port 164.

The ESU-argon beam coagulator pencil apparatus 121 may be used in threepossible modes--as an ESU pencil for cutting and coagulation (withoutargon beam), as an argon-beam enhanced ESU pencil for cutting andcoagulation, and as a pure argon beam coagulator. When the ESU-argonbeam coagulator pencil apparatus 121 is to be used for cutting andcoagulation without the argon beam, the RF hand switch 104 isalternatively placed in the cutting and coagulation positions, while theargon hand switch 150 remains in the off position. The nozzle assembly111 is adjusted (by moving the nozzle assembly 111 to and fro) over thetelescopic assembly 124 to expose the desired length of the electrode112. The nozzle assembly 111 is positioned over the telescopic assembly124 so as to maximize the suction on the operation site withouthampering visibility of the tip of the electrode 112 or of the operationsite. The optimal position of the nozzle 111 is a matter of personalpreference of the surgeon.

When the ESU-argon beam coagulator pencil apparatus 121 needs to be usedas an argon-beam coagulation enhanced ESU pencil for cutting andcoagulation, then the RF hand switch 104 is alternatively placed in thecutting or coagulation position, and the argon hand switch 150 is switchon. The nozzle assembly 111 is adjusted to maximize the efficiency ofthe argon beam, the efficiency of the removal of the smoke and otherfluids from the site of the operation, and the visibility of both thetip of the electrode and the site of the operation. The optimal positionof the nozzle 111, once again, is dictated by the personal preference ofthe surgeon.

In the final mode, when the ESU-argon beam coagulator pencil apparatus121 needs to be used purely as an argon-beam coagulator, the RF handswitch 104 is switched to the coagulation position, and the argon handswitch 150 is switch on. Because the electrode 112 is not required forthis procedure, the nozzle assembly 111 is moved out to cover the tip ofthe electrode. To lock the nozzle assembly 111 in this position, thelocking tab 102 is maneuvered into the leg 161 of channel 120. Now themouth 154 of the conduit 152 becomes the distal tip of the wholeESU-argon beam coagulator 121. This allows the argon beam to be releasedvery close to the site of the procedure, thereby maximizing theefficiency of the argon beam. Suction is used to remove smoke and otherfluids created during the coagulation.

Referring to FIGS. 8A-G, the ESU pencil apparatus 402 is mounted in thehandpiece holder 421 of the shroud 410. A suction source (not shown) iscoupled to the shroud 410 through the exhaust port 416. The smoke andother fluids from the operation site are sucked into the passageway 428inside the nozzle 412 through the exhaust opening 424. The chute 420conveys smoke and other debris from the passageway 428 to a debriscollector (not shown) via the exhaust port 416 and the smoke evacuationchannel (not shown).

Since the narrow exhaust opening 424 leads into a wider passageway 428inside the nozzle 412, the nozzle 412 produces a venturi effect on thefluids flowing into the nozzle 412, causing an acceleration of thesefluids as they pass through the exhaust opening 424. Further, thepressure drop in the passageway 428 immediately beyond the exhaustopening 424 is large enough to produce a spiraling or "vortex" fluidflow through the nozzle 412. This vortex soon extends to surround thetip of the electrode 406. Note, while providing structures(such asvanes) inside the passageway 428 can enhance the efficiency of thevortex, such structures are not a requirement for the creation of avortex. Since the passageway 428 widens sharply from the exhaust opening424 towards the connecting neck 428, the pressure lost in the passageway428 is minimal.

Nozzle 412 is replaced with the elongated nozzle 425 when the extendedelectrode 430 is to be used with the ESU pencil apparatus 402. Thispermits efficient collection of the fluids from near the blade tip 436.As explained previously, a vortex is created by the venturi effect atthe entrance of the nozzle 425. Further, the slanted fins 434 augmentthe vortex created by the venturi effect.

FIGS. 9A-B, and 10A-B show two more embodiments of the present inventionfor use with two types of ESU-argon beam coagulator pencils. FIGS. 9A-Bshow the adoption of the shroud 510 for use with an ESU pencil apparatus502 which has an argon beam (for coagulation) surrounding the electrode507. A suction source (not shown) is coupled to the shroud 510 throughthe exhaust port 516. Since the smoke inlet 524 is narrow and opens intoa relatively wider passageway inside the nozzle 512, a venturi effectcauses the fluids passing through the smoke inlet 524 to accelerate. Asexplained earlier, when the smoke and other fluids accelerate throughthe smoke inlet 524, the rushing fluids spirals and form a vortex. Thisvortex increases the efficiency of the evacuation of the fluidsgenerated at the site of the operation

In FIG. 9A, when the electrode 506 is retracted, the ESU pencilapparatus 502 is to be used purely as an argon beam coagulator. The RFhand switch 503 is set to the coagulation position and the argon handswitch 504 is turned on. The suction source (not shown) is also turnedon to remove smoke and other fluids produced during the coagulationprocess. The nozzle 512 is retracted, so that the conduit tip 532extends beyond the nozzle tip 524 thereby permitting uninterruptedpassage of the argon beam from the argon conduit 530 to the operationsite. Now, if the electrode 506 is extended, and the the RF switch 503is alternatively placed in cutting and coagulation positions, thecutting and coagulation functions of the ESU pencil apparatus isenhanced by the argon beam.

In FIG. 9B, the ESU pencil apparatus 502 is to be used as a normal ESUpencil (i.e. without an argon beam). The electrode 506 and the nozzle512 are extended. The RF hand switch 503 is alternatively placed in thecutting and coagulation position and the argon hand switch 504 is switchoff.

The operation of the apparatus in FIGS. 10A-B is similar to thatexplained above for the apparatus in FIGS. 9A-B. The shroud 610 has beenadapted for use with an ESU pencil apparatus 602 which has an argon beam(for coagulation) set apart from the electrode 606.

A suction source (not shown) is coupled to the shroud 610 through theexhaust port 616. As explained earlier, the venturi effect acceleratesthe smoke and other fluids through the smoke inlet 624 and forms avortex around the electrode 606. This vortex increases the efficiency ofthe evacuation of the fluids generated at the site of the operation

When the electrode 606 is retracted, the ESU pencil apparatus 602 is tobe used purely as a coagulator. When the ESU pencil apparatus 602 isused for cutting, the electrode 606 is extended. The suction source (notshown) is switched on, and the argon supply switch 504 is turned off.When the ESU pencil apparatus 602 is to be used simultaneously as bothan ESU pencil for cutting and an argon beam coagulator (as an "argonbeam coagulator enhanced ESU cutting pencil"), the electrode 606 isextended. The RF hand switch 603 is set to cut, and the argon hand 604is turned on. The nozzle 612 shield the argon beam from the suction.

Referring to FIG. 11A-D, the present invention has been adapted to workwith a laser surgical pencil apparatus 702. A suction source (not shown)is applied to the exhaust port 716 which sucks in smoke and other fluidsinto the smoke inlet 724 from site of the operation. Since the smokeinlet 724 is narrow and opens into a relatively wider exhaust chute 720,a venturi effect causes the fluids passing through the smoke inlet 724to accelerate. As explained earlier, when the smoke and other fluidsaccelerate through the smoke inlet 724, the rushing fluids spirals andform a vortex. This vortex increases the efficiency of the evacuation ofthe fluids generated at the site of the operation.

While the invention has been particularly shown and described withreference to the preferred embodiments thereof, it will be understood bythose skilled in the art that the foregoing and other changes in formand details may be made therein without departing from the spirit andscope of the invention. For example, any of the previous embodiments ofthe invention may be modified to include a means for regulating thesuction applied to remove the smoke and other fluids from the site ofthe operation.

Also, if desired, a telescopic member could be achieved by using a screwtype arrangement, a rack and pinion arrangement, or a series of notchesand corresponding protrusion, as suggested by the nozzle arrangement inFIG. 7D.

What is claimed is:
 1. An electro-surgical unit (ESU) pencil apparatuscomprising, in combination:cutting means for cutting and coagulation ina medical procedure; smoke evacuation means coupled to said cuttingmeans for removing smoke and debris produced during said medicalprocedure; and telescopic member means coupled to said cutting means andto said smoke evacuation means for adjusting position of said cuttingmeans and said smoke evacuation means along a lengthwise axis of saidESU pencil apparatus.
 2. The apparatus of claim 1 wherein said smokeevacuation means comprises:a vacuum source; tubular member means coupledto said vacuum source for conveying said smoke and debris to said vacuumsource; locking means coupled to said tubular member means and to saidtelescopic member means for holding a selected portion of saidtelescopic member means; and nozzle means coupled to said telescopicmember means for evacuating said smoke and debris in proximity to aworking site for said medical procedure.
 3. The apparatus of claim 2wherein said nozzle means has connection means for removably connectingsaid nozzle means to said telescopic member means.
 4. The apparatus ofclaim 3 wherein said connection means comprises a protrusion from aportion of said nozzle means for insertion into a groove in said lockingmeans.
 5. The apparatus of claim 2 wherein a portion of said nozzlemeans has a tapered inner and outer surface area.
 6. The apparatus ofclaim 5 wherein said tapered inner surface area of said nozzle meansassists in forming vortex flow of said smoke and debris into and throughsaid ESU pencil apparatus.
 7. The apparatus of claim 2 wherein anexternal surface portion of said locking means has a threaded portionfor engagement with another threaded portion on an internal surfaceportion of said tubular member means.
 8. The apparatus of claim 7wherein said tubular member means has a tapered inner surface areaportion in proximity to said another threaded portion.
 9. The apparatusof claim 8 wherein said locking means has a tubular portion havingserrated edge means for clamping around said selected portion of saidtelescopic member means when said tapered inner surface area portion ofsaid tubular member means forces said serrated edge means around saidselected portion of said telescopic member means as said locking meansis inserted into said tubular member means.
 10. The apparatus of claim 9further including conductive element means coupled to an interiorsurface of said tubular member means for conducting energy supplied froman energy source.
 11. The apparatus of claim 10 wherein said conductiveelement means comprises a tubular member extending substantially thefull length of said tubular member means.
 12. The apparatus of claim 10wherein said telescopic member means comprises:a tubular member slidablyretained within said conductive element means; conductive cap meanscoupled to a portion of said tubular member for conducting said energy;conductive tang means, extending from a portion of said conductive capmeans and contacting an inner surface portion of said conductive elementmeans, for conducting said energy from said conductive element means tosaid conductive cap means; conducting member means supported within saidtubular member for conducting said energy from said conductive capmeans; conductive support means coupled between said conductive capmeans and said conducting member means for conducting said energy fromsaid conductive cap means to said conducting member means; electroderetainer means coupled to said conducting member means for retainingsaid cutting means and for transferring said energy to said cuttingmeans; and vortex support means coupled to said conducting member meansfor supporting said conducting member means and for assisting formationof vortex flow of said smoke and debris.
 13. The apparatus of claim 10further including switch means for selectively applying said energy fromsaid energy source via a connector to said conductive element means. 14.The apparatus of claim 1 wherein adjustment of said telescopic membermeans changes volume of a cavity for carrying said smoke and debris, andchanges overall length of said ESU pencil apparatus.
 15. The apparatusof claim 14 wherein said cavity is comprised of a tubular cavity incommunication with a cylindrical cavity, and said tubular cavity andsaid cylindrical cavity are coaxial with said lengthwise axis of saidESU pencil apparatus.
 16. A method of operating an electro-surgical unit(ESU) pencil apparatus comprising the steps of:coupling cutting means tosaid ESU pencil apparatus for cutting and coagulation in a medicalprocedure; coupling smoke evacuation means to said cutting means forremoving smoke and debris produced during said medical procedure; andsliding telescopic member means coupled to said cutting means and tosaid smoke evacuation means for adjusting position of said cutting meansand said smoke evacuation means along a lengthwise axis of said ESUpencil apparatus.